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Biomedical subjects

Paula P Schnurr

Publications and source records attributed to Paula P Schnurr.

18 recordsLinked to original sources
PubMed2006

Longitudinal analysis of the relationship between symptoms and quality of life in veterans treated for posttraumatic stress disorder.

This study examined how change in posttraumatic stress disorder (PTSD) symptoms relates to change in quality of life. The sample consisted of 325 male Vietnam veterans with chronic PTSD who participated in a randomized trial of group psychotherapy. Latent growth modeling was used to test for synchronous effects of PTSD symptom change on psychosocial and physical health-related quality of life within the same time period and lagged effects of initial PTSD symptom change on later change in quality of life. PTSD symptoms were associated with reduced quality of life before treatment. There were synchronous effects of symptom change on change in quality of life but no significant lagged effects. Results indicate the importance of measuring quality of life in future investigations of PTSD treatment.

Adult↗
PubMed2006

Cognitive processing therapy for veterans with military-related posttraumatic stress disorder.

Sixty veterans (54 men, 6 women) with chronic military-related posttraumatic stress disorder (PTSD) participated in a wait-list controlled trial of cognitive processing therapy (CPT). The overall dropout rate was 16.6% (20% from CPT, 13% from waiting list). Random regression analyses of the intention-to-treat sample revealed significant improvements in PTSD and comorbid symptoms in the CPT condition compared with the wait-list condition. Forty percent of the intention-to-treat sample receiving CPT did not meet criteria for a PTSD diagnosis, and 50% had a reliable change in their PTSD symptoms at posttreatment assessment. There was no relationship between PTSD disability status and outcomes. This trial provides some of the most encouraging results of PTSD treatment for veterans with chronic PTSD and supports increased use of cognitive- behavioral treatments in this population.

Chronic Disease↗
PubMed2006

Toward a VA Women's Health Research Agenda: setting evidence-based priorities to improve the health and health care of women veterans.

The expansion of women in the military is reshaping the veteran population, with women now constituting the fastest growing segment of eligible VA health care users. In recognition of the changing demographics and special health care needs of women, the VA Office of Research & Development recently sponsored the first national VA Women's Health Research Agenda-setting conference to map research priorities to the needs of women veterans and position VA as a national leader in Women's Health Research. This paper summarizes the process and outcomes of this effort, outlining VA's research priorities for biomedical, clinical, rehabilitation, and health services research.

Delivery of Health Care↗
PubMed2005

Issues in the design of multisite clinical trials of psychotherapy: VA Cooperative Study No. 494 as an example.

This article describes issues in the design of an ongoing multisite randomized clinical trial of psychotherapy for treating posttraumatic stress disorder (PTSD) in female veterans and active duty personnel. Research aimed at testing treatments for PTSD in women who have served in the military is especially important due to the high prevalence of PTSD in this population. VA Cooperative Study 494 was designed to enroll 384 participants across 12 sites. Participants are randomly assigned to receive 10 weekly sessions of individual psychotherapy: Prolonged Exposure, a specific cognitive-behavioral therapy protocol for PTSD, or present-centered therapy, a comparison treatment that addresses current interpersonal problems but avoids a trauma focus. PTSD is the primary outcome. Additional outcomes are comorbid problems such as depression and anxiety; psychosocial function and quality of life; physical health status; satisfaction with treatment; and service utilization. Follow-up assessments are conducted at the end of treatment and then 3 and 6 months after treatment. Both treatments are delivered according to a manual. Videotapes of therapy sessions are viewed by experts who provide feedback to therapists throughout the trial to ensure adherence to the treatment manual. Discussion includes issues encountered in multisite psychotherapy trials along with the rationale for our decisions about how we addressed these issues in CSP #494.

Female↗
PubMed2005

Employment outcomes and PTSD symptom severity.

A diagnosis of chronic war-related posttraumatic stress disorder (PTSD) has been linked consistently to poor employment outcomes. This study investigates the relation further, analyzing how symptom severity correlates with work status, occupation type, and earnings. Study participants were male Vietnam veterans with severe or very severe PTSD who received treatment in the Department of Veterans Affairs system (N = 325). Veterans with more severe symptoms were more likely to work part-time or not at all. Among workers, more severe symptoms were weakly associated with having a sales or clerical position. Conditional on employment and occupation category, there was no significant relation between PTSD symptom level and earnings. Alternative PTSD symptom measures produced similar results. Our findings suggest that even modest reductions in PTSD symptoms may lead to employment gains, even if the overall symptom level remains severe.

Adult↗
PubMed2005

Randomized trial of cognitive-behavioral therapy for chronic posttraumatic stress disorder in adult female survivors of childhood sexual abuse.

The authors conducted a randomized clinical trial of individual psychotherapy for women with posttraumatic stress disorder (PTSD) related to childhood sexual abuse (n = 74), comparing cognitive-behavioral therapy (CBT) with a problem-solving therapy (present-centered therapy; PCT) and to a wait-list (WL). The authors hypothesized that CBT would be more effective than PCT and WL in decreasing PTSD and related symptoms. CBT participants were significantly more likely than PCT participants to no longer meet criteria for a PTSD diagnosis at follow-up assessments. CBT and PCT were superior to WL in decreasing PTSD symptoms and secondary measures. CBT had a significantly greater dropout rate than PCT and WL. Both CBT and PCT were associated with sustained symptom reduction in this sample.

Adult↗
PubMed2005

A longitudinal study of retirement in older male veterans.

In this study, the authors examined the effect of retirement on psychological and physical symptoms in 404 older male veterans who were taking part in an ongoing longitudinal study. Hierarchical linear modeling was used to analyze symptom trajectories from preretirement, peri-retirement, and postretirement periods in veterans with either lifetime full or partial posttraumatic stress disorder (PTSD), trauma exposure only, or no traumatic exposure. As expected, the PTSD group experienced greater increases in psychological and physical symptoms during retirement, relative to the other groups. Retirement due to poor health in the PTSD group did not account for the findings regarding physical symptoms. Results indicate that clinicians should recognize and address the potential for older individuals with PTSD to experience difficulties during retirement.

Adult↗
PubMed2004

Risk factors for the development versus maintenance of posttraumatic stress disorder.

This study examined risk factors for posttraumatic stress disorder (PTSD) in Vietnam veterans: 68 women and 414 men of whom 88 were White, 63 Black, 80 Hispanic, 90 Native Hawaiian, and 93 Japanese American. Continuation ratio logistic regression was used to compare the predictive power of risk factors for the development versus maintenance of full or partial PTSD. The development of PTSD was related to premilitary, military, and postmilitary factors. The maintenance of PTSD was related primarily to military and postmilitary factors. Multivariate analyses identified different models for development and maintenance. We conclude that development of PTSD is related to factors that occur before, during, and after a traumatic event, whereas failure to recover is related primarily to factors that occur during and after the event.

Adult↗
PubMed2004

Posttraumatic stress disorder symptoms, physical health, and health care utilization 50 years after repeated exposure to a toxic gas.

The posttraumatic sequelae of contaminant exposure are a contemporary international concern due to the threats posed to military personnel and civilians by war and bioterrorism. The role of PTSD symptoms as a mediator between potentially traumatic toxin exposure and physical health outcomes was examined with structural equation modeling in a probability sample of 302 male World War II-era U.S. military veterans 50 years after exposure to mustard gas tests. Controlling for age and psychological distress, the most parsimonious structural model involved PTSD symptoms mediating the relationship between toxin exposure and physical health problems, and physical health problems mediating the relationship between PTSD symptoms and outpatient health care utilization. Implications for researchers, mental health clinicians, and health care providers are discussed.

Aged↗
PubMed2004

A mediational model of PTSD in World War II veterans exposed to mustard gas.

Structural equation modeling (SEM) was used to examine associations among trauma-related contextual factors, initial psychological reactions, social support, and subsequent disclosure on posttraumatic stress disorder (PTSD) symptoms in a sample of World War II (WWII) veterans exposed to mustard gas (N = 305). A structural model suggested that initial psychological reaction mediated the relationship between variables related to the context of mustard gas exposure and severity of PTSD symptoms 50 years later. Unexpectedly, social support appeared to be positively related to PTSD symptoms, and not related to the contextual variables or initial psychological reactions. These findings contribute to our understanding of PTSD in older veterans, and have relevance for early intervention services to prevent PTSD among those at risk for exposure to toxic agents.

Aged↗
PubMed2004

Cognitive-Behavioral Couple's Treatment for posttraumatic stress disorder: initial findings.

This pilot study was an initial investigation of Cognitive-Behavioral Couple's Treatment (CBCT) for posttraumatic stress disorder (PTSD). Seven couples in which the husband was diagnosed with PTSD secondary to Vietnam combat experiences completed the treatment. According to independent clinician assessment and partner report, the veterans had substantial improvements in their PTSD symptoms. The veterans reported less dramatic improvements in their PTSD symptoms, but endorsed significant improvements in their depression and anxiety. The partners reported improved relationship satisfaction, whereas the veterans' relationship satisfaction was unchanged across treatment. The current findings are compared with findings on other forms of empirically validated treatment for PTSD and previous studies of CBCT for various individual problems. Theoretical implications and future directions are offered.

Adult↗
PubMed2004

The Hawaii Vietnam Veterans Project: is minority status a risk factor for posttraumatic stress disorder?

The Hawaii Vietnam Veterans Project (HVVP) was congressionally mandated as a follow-up to the National Vietnam Veterans Readjustment Study (NVVRS) to assess current and lifetime prevalence of posttraumatic stress disorder (PTSD). The Hawaii Vietnam Veterans Project used the original two-stage NVVRS design in which a lay interview, conducted with a large sample, was followed by a clinical interview with a smaller subsample. Reported results are from the clinical subsample consisting of 100 Native Hawaiian and 102 American of Japanese ancestry veterans compared with white veterans from the NVVRS cohort. The major finding is that veterans of Japanese ancestry exhibited significantly lower prevalence of current full, current partial, and lifetime full PTSD than white veterans. Adjustment for age and war zone exposure did not eliminate most of these differences. These results indicate that minority status per se is not a risk factor for PTSD.

Adaptation, Psychological↗
PubMed2004

Understanding relationships among trauma, post-tramatic stress disorder, and health outcomes.

Since Selye first published his classic work, The Stress of Life, a great deal of research has investigated the relationship between stress and physical health. Most of this research has focused on stressors such as divorce, bereavement, and job loss, but some has examined the health effects associated with extreme stressors, including war, sexual victimization, disasters, and serious accidents. The evidence presented here shows that poor physical health should be recognized, along with mental health problems and impaired psychosocial functioning, as an outcome of traumatic exposure. PTSD and other clinically significant distress reactions are a key step in triggering the processes through which exposure affects health. These processes involve psychological, biological, behavioral, and attentional mechanisms that interact to strain the body's ability to adapt, thereby increasing the likelihood of disease and illness behavior. However, by addressing the physical health consequences of traumatic exposure in treatment and treatment systems, the burden on individuals and society may be reduced.

Attitude to Health↗
PubMed2003

Randomized trial of trauma-focused group therapy for posttraumatic stress disorder: results from a department of veterans affairs cooperative study.

BACKGROUND: Department of Veterans Affairs Cooperative Study 420 is a randomized clinical trial of 2 methods of group psychotherapy for treating posttraumatic stress disorder (PTSD) in male Vietnam veterans. METHODS: Vietnam veterans (360 men) were randomly assigned to receive trauma-focused group psychotherapy or a present-centered comparison treatment that avoided trauma focus. Treatment was provided weekly to groups of 6 members for 30 weeks, followed by 5 monthly booster sessions. Severity of PTSD was the primary outcome. Additional measures were other psychiatric symptoms, functional status, quality of life, physical health, and service utilization. Follow-up assessments were conducted at the end of treatment (7 months) and at the end of the booster sessions (12 months); 325 individuals participated in 1 or both assessments. Additional follow-up for PTSD severity was performed in a subset of participants at 18 and 24 months. RESULTS: Although posttreatment assessments of PTSD severity and other measures were significantly improved from baseline, intention-to-treat analyses found no overall differences between therapy groups on any outcome. Analyses of data from participants who received an adequate dose of treatment suggested that trauma-focused group therapy reduced avoidance and numbing and, possibly, PTSD symptoms. Dropout from treatment was higher in trauma-focused group treatment. Average improvement was modest in both treatments, although approximately 40% of participants showed clinically significant change. CONCLUSIONS: This study did not find a treatment effect for trauma-focused group therapy. The difference between the effectiveness and adequate dose findings suggests the possible value of methods to enhance the delivery of cognitive-behavioral treatments in clinical practice settings.

Ambulatory Care↗
PubMed2003

A descriptive analysis of PTSD chronicity in Vietnam veterans.

This study examined the chronicity of PTSD in 530 male and female Vietnam veterans who were drawn from 2 large, ethnically diverse samples. Delayed onset was common, as was a failure to fully remit: 78% of the 239 veterans with full or partial lifetime PTSD were symptomatic in the 3 months prior to assessment. Cluster analysis identified 4 subtypes of posttraumatic response, with women most likely to be in a delayed onset cluster, and minority men most likely to be in a severe chronic cluster. The extent of chronicity observed in this sample underscores the need for treatments that address the persistence of posttraumatic symptoms.

Chronic Disease↗
PubMed2002

Research on posttraumatic stress disorder: epidemiology, pathophysiology, and assessment.

Posttraumatic stress disorder (PTSD) is a highly prevalent disorder in both clinical and community populations. This article reviews current knowledge about PTSD in order to assist clinicians in the diagnosis and treatment of reactions to traumatic life events. First, research findings are presented, followed by guidelines for the assessment of trauma and PTSD. Topics discussed include epidemiology, course, and comorbidity, as well as information processing and psychobiology. The review is limited to information about PTSD in adults, although some of the material may generalize to child and adolescent populations.

Acute Disease↗